Healthcare Provider Details

I. General information

NPI: 1689672453
Provider Name (Legal Business Name): LANE S RAKER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 GREENBRIER PKWY SUITE 100
CHESAPEAKE VA
23320-3697
US

IV. Provider business mailing address

914 GRAYDON AVE
NORFOLK VA
23507-1208
US

V. Phone/Fax

Practice location:
  • Phone: 757-410-7390
  • Fax: 757-410-7395
Mailing address:
  • Phone: 757-624-9518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number0024062335
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: